Appendicitis pathophysiology: Difference between revisions

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Latest revision as of 20:27, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farwa Haideri [2]

Overview

Appendicitis is caused by the obstruction of the tubular space inside the appendix. This initial problem is compounded into a cascade of events that lead to the inflammation of the appendix, the obstruction of the blood vessels supplying it, and infection. Once these blood vessels are obstructed, appendiceal tissue starts to die and leak out its cellular components.

Pathophysiology

Pathogenesis

On the basis of experimental evidence, acute appendicitis is the end result of a primary obstruction of the appendiceal lumen.^[1]
Appendiceal luminar obstructions are a common inciting event leading to inflammation.^[2]
- Appendiceal obstructions can be caused by:^[2]
  - Fecaliths
  - Lymphoid Hyperplasia
  - Benign or malignant tumors
  - Infectious processes
- Obstructions can lead to an increase in endoluminar and intramural pressure, which can result in an occlusion of the venules in the appendiceal wall.
  - The appendix can fill with mucus and distends.
  - The increase in pressure leads to thrombosis and occlusion of the small vessels, and stasis of lymphatic flow.

Associated Conditions

Associated conditions of appendicitis include:^[2]

Intestinal obstruction
Inflammatory bowel disease
Pelvic inflammatory disease and other gynecological disorders
Intestinal adhesions
Constipation

Gross Pathology

Inflammation of the appendiceal wall can result in perforation and development of a contained abscess or generalized peritonitis.
The wall of the appendix can become ischemic as vascular and lymphatic occlusion progress.^[2]

Inflammed appendix
source:Case courtesy of Dr Andrew Dixon, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/9644">rID: 9644</a>

References

↑ Wangensteen OH, Bowers WF. Significance of the obstructive factor in the genesis of acute appendicitis. Arch Surg 1937;34:496-526
↑ ^2.0 ^2.1 ^2.2 ^2.3 Yelon, Jay A. & Luchette, Fred A. (2014), Geriatric Trauma and Critical Care (1st ed.), New York, New York: Springer

Template:WH Template:WS

[1] Wangensteen OH, Bowers WF. Significance of the obstructive factor in the genesis of acute appendicitis. Arch Surg 1937;34:496-526

[book1-2] 2.0 ^2.1 ^2.2 ^2.3 Yelon, Jay A. & Luchette, Fred A. (2014), Geriatric Trauma and Critical Care (1st ed.), New York, New York: Springer

[1]

[2]

@@ Line 1: / Line 1: @@
+<div style="-webkit-user-select: none;">
+{|class="infobox" style="position: fixed; top: 65%; right: 10px; margin: 0 0 0 0; border: 0; float: right;
+|-
+| {{#ev:youtube|https://https://www.youtube.com/watch?v=r9amif1DQMc|350}}
+|-
+|}
+__NOTOC__
 {{Appendicitis}}
-{{CMG}}
+{{CMG}}; {{AE}} {{FH}}
 ==Overview==
-Appendicitis is caused by the obstruction of the [[Lumen (anatomy)|tubular space]] inside the appendix.  This initial problem is compounded into a cascade of events that lead to the inflammation of the appendix and the obstruction of the blood vessels supplying it.  Once these blood vessels are obstructed, appendiceal tissue starts to die and leak out its cellular components.  If the disease is not treated, eventually the appendix will rupture which could lead to death.
+Appendicitis is caused by the obstruction of the [[Lumen (anatomy)|tubular space]] inside the [[appendix]]. This initial problem is compounded into a cascade of events that lead to the [[inflammation]] of the [[appendix]], the [[obstruction]] of the blood vessels supplying it, and [[infection]].  Once these blood vessels are obstructed, appendiceal tissue starts to die and leak out its cellular components.
 ==Pathophysiology==
-# On the basis of experimental evidence, acute appendicitis seems to be the end result of a primary obstruction of the appendix [[lumen]]<ref> Wangensteen OH, Bowers WF. Significance of the obstructive factor in the genesis of acute appendicitis. Arch Surg 1937;34:496-526 </ref><ref> Pieper R, Kager L, Tidefelt U.Obstruction of appendix vermiformis causing acute appendicitis: An experimental study in rabbit. Acta Chir Scand 1982;148:63-72 </ref>.
+===Pathogenesis===
-# Once this obstruction occurs, the appendix subsequently becomes filled with mucus and distends, increasing intraluminal and intramural pressures.
+*On the basis of experimental evidence, acute appendicitis is the end result of a primary obstruction of the appendiceal [[lumen]].<ref> Wangensteen OH, Bowers WF. Significance of the obstructive factor in the genesis of acute appendicitis. Arch Surg 1937;34:496-526 </ref>
-# The increase in pressure leads to [[thrombosis]] and [[occlusion]] of the small vessels, and the stasis of lymphatic flow.
+*Appendiceal luminar obstructions are a common inciting event leading to inflammation.<ref name="book1">{{Citation
-# As these clots and blockages progress, the appendix becomes [[ischemic]] and then [[necrotic]].
+| last1  = Yelon
-# Rarely, spontaneous recovery can occur at this point. As bacteria begin to leak out through the dying walls, pus forms within and around the appendix ([[suppuration]]).
+| first1 = Jay A.
-# The end result of this cascade is appendiceal rupture causing [[peritonitis]], which may lead to [[septicemia]] and eventually death.
+| last2  = Luchette
+| first2 = Fred A.
+| lastauthoramp = yes
+| title     = Geriatric Trauma and Critical Care
+| publisher = Springer
+| place     = New York, New York
+| edition = 1st
+| year    = 2014
+}}</ref>
+**Appendiceal obstructions can be caused by:<ref name="book1">{{Citation
+| last1  = Yelon
+| first1 = Jay A.
+| last2  = Luchette
+| first2 = Fred A.
+| lastauthoramp = yes
+| title     = Geriatric Trauma and Critical Care
+| publisher = Springer
+| place     = New York, New York
+| edition = 1st
+| year    = 2014
+}}</ref>
+*** [[Fecaliths]]
+*** [[Lymphoid Hyperplasia]]
+*** Benign or malignant [[tumors]]
+*** Infectious processes
+** Obstructions can lead to an increase in [[endoluminar]] and [[intramural]] pressure, which can result in an occlusion of the [[venules]] in the appendiceal wall.
+*** The [[appendix]] can fill with [[mucus]] and distends.
+***The increase in pressure leads to [[thrombosis]] and [[occlusion]] of the small vessels, and stasis of lymphatic flow.
-==Associated Conditions==
+===Associated Conditions===
-Associated conditions of Appendicitis include:
+Associated conditions of appendicitis include:<ref name="book1">{{Citation
-* Intestinal obstruction
+| last1  = Yelon
+| first1 = Jay A.
+| last2  = Luchette
+| first2 = Fred A.
+| lastauthoramp = yes
+| title     = Geriatric Trauma and Critical Care
+| publisher = Springer
+| place     = New York, New York
+| edition = 1st
+| year    = 2014
+}}</ref>
+* [[Intestinal obstruction]]
 * [[Inflammatory bowel disease]]
-* Pelvic inflammatory disease and other gynecological disorders
+* [[Pelvic inflammatory disease]] and other gynecological disorders
-* Intestinal adhesions
+* Intestinal [[adhesions]]
 * [[Constipation]]
+===Gross Pathology===
+* Inflammation of the appendiceal wall can result in [[perforation]] and development of a contained [[abscess]] or generalized [[peritonitis]].
+*The wall of the [[appendix]] can become ischemic as vascular and lymphatic [[occlusion]] progress.<ref name="book1">{{Citation
+| last1  = Yelon
+| first1 = Jay A.
+| last2  = Luchette
+| first2 = Fred A.
+| lastauthoramp = yes
+| title     = Geriatric Trauma and Critical Care
+| publisher = Springer
+| place     = New York, New York
+| edition = 1st
+| year    = 2014
+}}</ref>
+[[Image:Appendicitis-gross-pathology.png|500px|center|thumb|Inflammed appendix <br>source:Case courtesy of Dr Andrew Dixon, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/9644">rID: 9644</a>]]
 ==References==
-{{reflist|2}}
+{{Reflist|2}}
+{{WH}}
+{{WS}}
+[[Category:Emergency medicine]]
+[[Category:Surgery]]
+[[Category:Gastroenterology]]